Mini-Dachshund 11y/o Cushings Diagnosis - Trilostane

[Anniston's Mom]

So glad to have stumbled onto this forum. Though just registered, I have found much helpful and hopeful information over the past few weeks. This is a long post, but I thought I would get the history nailed down in the beginning. Anniston (we actually call her Anni) is a mini-Dachshund who will be 11 years old later this month. A week ago, her weight was 9.2 pounds. Health overall has been very good. No back problems. An occasional UTI or ear infection. A couple of years ago a senior profile revealed that she needed to begin taking meds for thyroid. She takes a 100 mcg Levothyroxine tablet twice daily and recently added Ursodiol daily. Trilostane is her Cushings med, but read the history below. We have Prednisone for an emergency.

• April, 2012 – began to notice an increase in thirst and hunger. Our well house-trained girl started having accidents. Suspected diabetes when UTI was ruled out.
• 5/31/12 – tested for diabetes and kidney issues. Tested normal except slightly high ALT and ALKP. Negative diabetes and kidney issues led vet to suspect Cushings and she certainly had many of the symptoms.
• 6/7/12 - ACTH STIM Results PRE 9.0 ug/dl Post >50 ug/dls. Vet disgnosed Cushings and started on Lysodren 1/8 of a 500 mg tablet.every other day. Her vet wanted to do a slow load to try to avoid side effects. At that point her weight was 10 pounds and we started measuring her water. It was around 30 ounces and increasing.
• 7/9/12 – increased Lysodren - 1/8 tablet two days on and one day off. Still no change in symptoms. The only noticeable side effect was a pinching look in her face for a couple of hours after taking the med.
• 7/21/12 – started daily dosing, then increased Lysodren to 1/6 of 500 mg tablet 7/26/12. Water consumption continued to increase to the 40-55 ounce range daily.
• Mid August – changed to Ketaconazole, but only dosed for a few days as Vet was able to quickly schedule appointment for ultrasound with specialist.
• 8/24/12 - Abdominal Ultrasound. Several comments. He suggested putting her on Ursadiol to improve bilary flow and reduce the risk of a mucocele developing and also changing to Trilostane as there had been zero response to the Lysodren. He suspected stubborn pituitary Cushings. Suggested 3 days off meds then beginning Trilostane
• 8/26/12 – started Trilostane at 15 mg daily. Within three days water consumption had dropped from the low 50 ounce range to the mid 30’s where it remained. 9/12/12 – increased Trilostane to 30 mg dosed half in morning and half in evening. Water comsumption continued to drop and appetite remained steady until late September at which time she weighed 9 pounds, was drinking 8-12 ounces of water, but beginning to refuse her kibble (she has been on Eukanuba her whole life.)
• 9/14/2012 – Repeat ACTH STIM – Pre-ACTH 2.2 ug/dl Post-ACTH 1.8 ug/dl. Recommended continuing 30 mg daily dose administered ½ morning & evening.
• A couple of weeks ago, her skin turned incredibly dry. Stomach began to peel like a bad sunburn. It is better and today we notice a light fuzz of hair returning on stomach.
• For the past week, it has been difficult to get her to eat anything other than a chicken treat or boiled chicken. She is walking away from things we know she likes lots. The past few days, she has had a bit of diarrhea and vomiting, sleeping a lot, but still occasional playful moments. Right or wrong, I took her off the Trilostane two days ago (Oct. 11) with the intent to keep her off of it for one week then put her on a daily 15 mg dose for two weeks before repeating the ACHT SSTIM test.

We would be so very grateful for any insight from those who have walked this path.

[Harley PoMMom]

Welcome to you and Anni,

So sorry for the circumstances that brought you here but glad you found us.

During the Lysodren loading phase, therapy is usually begun with the owner administering Lysodren at a dosage of 50 mg/kg/day, divided and given BID (twice a day). Since Lysodren is a fat-soluble medicine a dog needs to take the meds with something that is high in fat content in order for the medication to be absorbed properly, such as the pill being fed in a bit of cream cheese or peanut butter. The Lysodren dose should always follow the main meal.

Since your vet did not follow the proper dosing "loading" protocol I can see why Anni did not load.

When switching from one medicine to another it is recommended to wait at least six weeks.

When using Trilostane an ACTH stim test is done 10-14 days after treatment begins. Also the timing of the ACTH is very important, it should be done 3-5 hours after the dose is given, plus Trilostane has to be given with food for it to be absorbed properly.

After any dosage change an ACTH stim test should be performed within 10-14 days. Since Anni had a low normal post of 1.8 ug/dl on 9/24 and now she is vomiting, having diarrhea, and is lethargic, I am suspecting Anni is exhibiting signs of too low cortisol.

Before the Trilostane is started an ACTH stim test should be performed to see if her cortisol has risen and if it has, I believe she should be started at a lower dose.

Hoping Anni is feeling much better soon and please know we will help in any way we can.

Love and hugs,
Lori

[Anniston's Mom]

I too suspect that her cortisol has fallen too low based on the symptoms. She has eaten a bit today and seems to be a little more active. To make sure I understand, you suggest that she should have the ACTH done before re-starting the Trilostane at 15mg? If so, how long do you suggest waiting before testing? The last ACTH was done with the correct timing because I had read the protocol on this site and passed it on to my vet. He is very caring and concerned, but I am a bit nervous as Anni is his first patient on Trilostane. He is out of town until mid-week so I independently decided to take her off the Trilo as she was not eating.

[Anniston's Mom]

...and I failed to say "thank you, thank you, thank you, Lori"! ...and "thank you, thank you, thank you, all who provide information about this nasty disease!". Until now, I've felt I was swimming upstream alone.

[Squirt's Mom]

Hi and welcome to you and Anni! :)

You will want to wait until she can do without the pred and the cush signs are back fairly strong. There needs to be at least 24 hours between the time of the last pred dose and the ACTH.

So when she is able to do ok without the pred and her signs are coming back, then you will want to schedule another ACTH before restarting the Trilo.

I'm glad you found us and look forward to learning more about the both of you as time passes. Never hesitate to ask questions and we will be glad to help in any way we can. You and Anni are part of the family and we will be by your side all the way.

Hugs,
Leslie and the gang

[Anniston's Mom]

Leslie, I actually never gave her the Pred though came mighty close, even pulling it down and taking the pill out. However, while not eating she was still drinking water, urinating normally, and had very short bursts of interest and activity. This is her third day off the Trilo and we can definitely see a difference in her interest. As of now she has nibbled soft food throughout the day with no diarrhea or vomiting.

Do you think a week is long enough off the Trilo before testing and likely re-starting? Or, should we wait until she is consuming lots more water? I really, really do not want her to get back up to 4,5,6, and even 7 cups. She is currently 7-12 ounces for the past few weeks which is about where she was before this all started. It was miserable for all of us. Thank goodness my husband is a very attentive Doxie Dad. We had a few weeks that it really took two of us just to get through the day. Someone asked him a couple of weeks ago what he did over the summer and his reply was "take Anni out".

[Squirt's Mom]

If she has had no pred and her water intake is increasing then it would probably be ok to schedule one for this coming week.

Was her appetite ever increased? Cushing's dogs typically have a voracious appetite - they literally act starved 24/7.

Hugs,
Leslie and the gang

[Anniston's Mom]

Anni has always been a picky eater and unlike most Doxies I have known she was never a big eater. She has always been very picky about both food and treats. However, we did have a few months before the Trilo when she just could not get enough to eat. So far, water intake has not gone up but I fully expect it to in the next day or so.

I am so grateful for the responses. I have read and researched for hours, but there is nothing to compare to advice, observations, and suggestions from those who have walked this path ahead of us.

[Harley PoMMom]

To make sure I understand, you suggest that she should have the ACTH done before re-starting the Trilostane at 15mg? If so, how long do you suggest waiting before testing?

If Anni is feeling more like herself than I believe an ACTH stim test can be performed as soon as you would want.


The last ACTH was done with the correct timing because I had read the protocol on this site and passed it on to my vet. He is very caring and concerned, but I am a bit nervous as Anni is his first patient on Trilostane. He is out of town until mid-week so I independently decided to take her off the Trilo as she was not eating.

That is great news that you are educating yourself about Cushing's and the Trilostane treatment protocols...Good job! Many of us have learned that our regular GP vets are not so knowledgeable about Cushing's and then got a referral to an IMS.

Also, taking her off the Trilostane was really important since she displaying signs of too low cortisol. You are doing a wonderful job!

Love and hugs,
Lori

[Anniston's Mom]

What is IMS? We are small town between Birmingham, AL and Atlanta, GA. I think we only have GP vets. Thankfully ours is not offended by information I offer. He has several Cushings patients, but Anni is his first to fail to respond to Lysodren making her his first Trilo patient.

[Harley PoMMom]

IMS is an internal medicine specialist. An IMS is the most knowledgable and experienced with cushing's and other endocrine disorders because they handle a lot more cases than a regular GP does.

Many members have their regular vets plus have an IMS for consulting purposes.

The bottom line is that one has to have a vet that is willing to work as a team player. A vet should listen to what the pet parent is saying and be able to answer any questions while making sure the pet parent fully understands everything...which is a tall order!!!

One of our Administrators, Marianne (labblab), is from Georgia, so hopefully she will be on soon.

[lulusmom]

Hi and welcome to you and Anni

I'm sorry for the reasons that brought you here but i'm glad you found us. So as to keep myself organized as well as those who read my ramblings, I've put my comments and questions below in blue within t he body of your post.



• April, 2012 – began to notice an increase in thirst and hunger. Our well house-trained girl started having accidents. Suspected diabetes when UTI was ruled out.

Did your vet do a urine culture because if not, Anni could still have a UTI. Cushdogs have very dilute urine and a normal urinalysis won't pick up all the white blood cells because they are diluted out. Onlyl a culture will detect them as well a tell the vet what type of bacteria is involved. Not all antibiotics treat all bacteria types.

• 5/31/12 – tested for diabetes and kidney issues. Tested normal except slightly high ALT and ALKP. Negative diabetes and kidney issues led vet to suspect Cushings and she certainly had many of the symptoms.
• 6/7/12 - ACTH STIM Results PRE 9.0 ug/dl Post >50 ug/dls. Vet disgnosed Cushings and started on Lysodren 1/8 of a 500 mg tablet.every other day. Her vet wanted to do a slow load to try to avoid side effects. At that point her weight was 10 pounds and we started measuring her water. It was around 30 ounces and
increasing.

Whoa, that is the smallest dose of Lysodren I've ever heard of. Recommended "daily" loading dose is 25mg/kg to 50mg/kg and most experienced vets will prescribe the max. Your vet prescribed a woefully scant dose of 62.5mg which is a bit under 15mg/kg. My tiny 4.5lb Pom loaded at 50mg twice a day and it took her about nine days to load. Average is 5 to 8. It is almost a certainty that Anni's dose would have absolutely no effect if given daily so at every other day, I think it was waste of money from the get go.

• 7/9/12 – increased Lysodren - 1/8 tablet two days on and one day off. Still no change in symptoms. The only noticeable side effect was a pinching look in her face for a couple of hours after taking the med.

The lack of results is not surprising, it would have been expected by an experienced gp or an internal medicine specialist.

• 7/21/12 – started daily dosing, then increased Lysodren to 1/6 of 500 mg tablet 7/26/12. Water consumption continued to increase to the 40-55 ounce range daily.

At this point, the minimum dose of at least 100mg/kg, divided into two 50mg dose am and pm should have been prescribed. Anni's increase amounted to a continued inadequate dose of 83mg/kg. It is no wonder that you saw no improvements. It is very apparent that your vet has had no continuing education on cushing's and is probably afraid of Lysodren. You mentioned in a subsequent post that your Anni is the only dog your vet has treated that has not responded. I have no idea how many dogs he has treated but if he followS the same unorthodox protocol for all of his patient, I would be shocked if any of them responded and if they did, it had to take weeks and weeks or months and months to achieve loading.


• Mid August – changed to Ketaconazole, but only dosed for a few days as Vet was able to quickly schedule appointment for ultrasound with specialist.

I'm glad you only had Anni on Ketaconazole for only a few days because it is tough on the liver. This drug is rarely used for cushing's these days because of that.

• 8/24/12 - Abdominal Ultrasound. Several comments. He suggested putting her on Ursadiol to improve bilary flow and reduce the risk of a mucocele developing and also changing to Trilostane as there had been zero response to the Lysodren. He suspected stubborn pituitary Cushings. Suggested 3 days off meds then beginning Trilostane

What did the ultrasound findings have to say about the appearance of the adrenal glands? Since no differentiation tests were done to determine the form of cushing's Anni has, the ultrasound should have made the determination. If a dog has pituitary dependent disease, both adrenals are enlarged but can be normal. If an adrenal tumor is involved, one adrenal gland will be larger than the other and the other gland will be much smaller or even atrophied from lack of use. Also a cushingoid dog usually has an enlarged liver. Was Anni's liver enlarged?

• 8/26/12 – started Trilostane at 15 mg daily. Within three days water consumption had dropped from the low 50 ounce range to the mid 30’s where it remained. 9/12/12 – increased Trilostane to 30 mg dosed half in morning and half in evening. Water comsumption continued to drop and appetite remained steady until late September at which time she weighed 9 pounds, was drinking 8-12 ounces of water, but beginning to refuse her kibble (she has been on Eukanuba her whole life.)

• 9/14/2012 – Repeat ACTH STIM – Pre-ACTH 2.2 ug/dl Post-ACTH 1.8 ug/dl. Recommended continuing 30 mg daily dose administered ½ morning & evening.

You mentioned in your prior bullet point that you increased dose to 15mg BID on 9/12/2012. Was the acth stim test actually done only two days after increasing the dose. If so, those results are scarey low for only two days on and to continue on with that dose would be quite risky.


• A couple of weeks ago, her skin turned incredibly dry. Stomach began to peel like a bad sunburn. It is better and today we notice a light fuzz of hair returning on stomach.

We've had a number of members report that their dogs got a funky coat and/or their skin was really flakey. I think this is a normal thing. However, if the dog is really itchy, it could be that high cortisol has been masking allergies for a very long time and as the cortisol continues to be reduced through treatment, the allergies will flare.

• For the past week, it has been difficult to get her to eat anything other than a chicken treat or boiled chicken. She is walking away from things we know she likes lots. The past few days, she has had a bit of diarrhea and vomiting, sleeping a lot, but still occasional playful moments. Right or wrong, I took her off the Trilostane two days ago (Oct. 11) with the intent to keep her off of it for one week then put her on a daily 15 mg dose for two weeks before repeating the ACHT SSTIM test.

You did the right thing and I personally would not restart her on the same dose. Knowing what I know now, I personally would feel more comfortable with 10mg am and pm.

We would be so very grateful for any insight from those who have walked this path.

I had two cushdogs until June when one of my babies passed. Both of them treated with Lysodren, then switched to Trilostane for two years and back to Lysodren. The reasons for the switches is a long story but I am quite familiar with both drugs. I'm a seven year canine cushing's veteran so I have walked down this path in your shoes. The only difference between us is that I've had seven years to educate myself....actually it's more like obsessive compulsive research. :D We're all here to make sure that you become the best advocate you can be for Anni. You are her only voice so we want you to use it. I think you are off to a fabulous start and Anni is one lucky girl to have you for her mom.



If you are interested in having Anni consult with an internal medicine specialist (FWIW, I think that's a good idea), I've included the URL to listing of specialist in Georgia I found at www.acvim.org

http://acvim.org/websites/acvim/index.php?p=228

Glynda

[labblab]

Hello and welcome from me, too!

You have already been given excellent feedback about Anniston's treatment experience thus far, so I just want to add a brief note about referral options. I do have a question, though. You mention that you were referred to a specialist for Anniston's ultrasound -- where was that specialist located, and was he/she the one who diagnosed the pituitary form of the disease and made the suggestion to switch to trilostane?

Barring further information about the specialist who did the ultrasound, I can tell you that my own Cushpup was diagnosed, treated, and received excellent care from Dr. Mark Dorfman who is the medical director at the Sandy Springs location of Georgia Veterinary Specialists in Atlanta. GVS is an extensive partnership of emergency and specialty vets, but I just visited their website and unfortunately it appears to be under reconstruction at the moment and the homepage only provides minimal information. Hopefully, the complete webpage will be operational again ASAP.

There are additionally other specialty practices in Atlanta, but I also want to mention the Auburn vet school. If you are located right near I -20, Atlanta may be the faster drive. But Auburn has an outstanding vet school and upon referral from your GP, I feel certain a consultation with the specialists at Auburn would also be an option for you. And the cost at Auburn might actually be a bit less than that associated with an Atlanta speciality practice. Dr. Ellen Behrend is located at Auburn, and is a foremost authority on Cushing's treatment. I am not certain whether she is currently seeing patients in clinical practice, but she is still serving as an endocrinology expert at Auburn.

Marianne

[molly muffin]

Hello and welcome :)
I'm so glad you found us. It does help to have others that you can "talk/type" to who are going through or have gone through the same things that you are. I know I've found it invaluable. Now I have tons of cushdogs and noncushdogs and people that I worry about on a daily basis. We do become a second family here and once you've joined, you're a part of that family, for better or worse, forever.
Everyone has covered the cushings options, crisis signs, and advice already. I'll just add that you are doing a wonderful job for Anni. Bravo, this disease isn't an easy task to learn about and everyday it seems something new can be learned.
You're doing great!

hugs,
Sharlene and Molly muffin

[Anniston's Mom]

POST EDITED - color applied to help see different responses in post
Glynda's words are in blue
Anni's Mom's in orange

To lulusmom,

To maintain the conversation, I too pasted in the earlier conversation. My responses are supposed to be in Orange, but I don't think they appear that way..

Originally Posted by Anniston's Mom
• April, 2012 – began to notice an increase in thirst and hunger. Our well house-trained girl started having accidents. Suspected diabetes when UTI was ruled out.

Did your vet do a urine culture because if not, Anni could still have a UTI. Cushdogs have very dilute urine and a normal urinalysis won't pick up all the white blood cells because they are diluted out. Only a culture will detect them as well a tell the vet what type of bacteria is involved. Not all antibiotics treat all bacteria types.

I do not know about a culture, but as soon as we started the Trilo and water intake dropped we have not had a single accident since.

• 5/31/12 – tested for diabetes and kidney issues. Tested normal except slightly high ALT and ALKP. Negative diabetes and kidney issues led vet to suspect Cushings and she certainly had many of the symptoms.

• 6/7/12 - ACTH STIM Results PRE 9.0 ug/dl Post >50 ug/dls. Vet disgnosed Cushings and started on Lysodren 1/8 of a 500 mg tablet.every other day. Her vet wanted to do a slow load to try to avoid side effects. At that point her weight was 10 pounds and we started measuring her water. It was around 30 ounces and increasing.

Whoa, that is the smallest dose of Lysodren I've ever heard of. Recommended "daily" loading dose is 25mg/kg to 50mg/kg and most experienced vets will prescribe the max. Your vet prescribed a woefully scant dose of 62.5mg which is a bit under 15mg/kg. My tiny 4.5lb Pom loaded at 50mg twice a day and it took her about nine days to load. Average is 5 to 8. It is almost a certainty that Anni's dose would have absolutely no effect if given daily so at every other day, I think it was waste of money from the get go.

• 7/9/12 – increased Lysodren - 1/8 tablet two days on and one day off. Still no change in symptoms. The only noticeable side effect was a pinching look in her face for a couple of hours after taking the med.

The lack of results is not surprising, it would have been expected by an experienced gp or an internal medicine specialist.

• 7/21/12 – started daily dosing, then increased Lysodren to 1/6 of 500 mg tablet 7/26/12. Water consumption continued to increase to the 40-55 ounce range daily.

At this point, the minimum dose of at least 100mg/kg, divided into two 50mg dose am and pm should have been prescribed. Anni's increase amounted to a continued inadequate dose of 83mg/kg. It is no wonder that you saw no improvements. It is very apparent that your vet has had no continuing education on cushing's and is probably afraid of Lysodren. You mentioned in a subsequent post that your Anni is the only dog your vet has treated that has not responded. I have no idea how many dogs he has treated but if he followS the same unorthodox protocol for all of his patient, I would be shocked if any of them responded and if they did, it had to take weeks and weeks or months and months to achieve loading.

Not defending our GP, but he came very highly recommended by at least 6 people when we were looking to change and I do know that he goes regularly to continuing ed classes, though perhaps not Cushings specific. Before we started Lysodren treatment, I asked about how many Cushings dogs he had. Through the years he has treated more than a dozen and I even talked to a lady with a small Doxie that he “loaded” the same way. It has been on Lysodren for 4+ years and doing well. Though in hindsight, likely wrong, it sounded reasonable at the time.

• Mid August – changed to Ketaconazole, but only dosed for a few days as Vet was able to quickly schedule appointment for ultrasound with specialist.

I'm glad you only had Anni on Ketaconazole for only a few days because it is tough on the liver. This drug is rarely used for cushing's these days because of that.

After reading about this drug, I agree with you.

• 8/24/12 - Abdominal Ultrasound. Several comments. He suggested putting her on Ursadiol to improve bilary flow and reduce the risk of a mucocele developing and also changing to Trilostane as there had been zero response to the Lysodren. He suspected stubborn pituitary Cushings. Suggested 3 days off meds then beginning Trilostane

What did the ultrasound findings have to say about the appearance of the adrenal glands? Since no differentiation tests were done to determine the form of cushing's Anni has, the ultrasound should have made the determination. If a dog has pituitary dependent disease, both adrenals are enlarged but can be normal. If an adrenal tumor is involved, one adrenal gland will be larger than the other and the other gland will be much smaller or even atrophied from lack of use. Also a cushingoid dog usually has an enlarged liver. Was Anni's liver enlarged?

I’ll reply to this one separately. I left that report on my desk at work.

• 8/26/12 – started Trilostane at 15 mg daily. Within three days water consumption had dropped from the low 50 ounce range to the mid 30’s where it remained. 9/12/12 – increased Trilostane to 30 mg dosed half in morning and half in evening. Water comsumption continued to drop and appetite remained steady until late September at which time she weighed 9 pounds, was drinking 8-12 ounces of water, but beginning to refuse her kibble (she has been on Eukanuba her whole life.)
• 9/14/2012 – Repeat ACTH STIM – Pre-ACTH 2.2 ug/dl Post-ACTH 1.8 ug/dl. Recommended continuing 30 mg daily dose administered ½ morning & evening.

You mentioned in your prior bullet point that you increased dose to 15mg BID on 9/12/2012. Was the acth stim test actually done only two days after increasing the dose. If so, those results are scarey low for only two days on and to continue on with that dose would be quite risky.

As we well found out. I took her off Trilo days ago. Today is #5. Did not give her Pred, though I surely considered it. Plan to do ACTH STIM on Thursday unless something changes.

• A couple of weeks ago, her skin turned incredibly dry. Stomach began to peel like a bad sunburn. It is better and today we notice a light fuzz of hair returning on stomach.

We've had a number of members report that their dogs got a funky coat and/or their skin was really flakey. I think this is a normal thing. However, if the dog is really itchy, it could be that high cortisol has been masking allergies for a very long time and as the cortisol continues to be reduced through treatment, the allergies will flare.

Not itch, thank goodness.

• For the past week, it has been difficult to get her to eat anything other than a chicken treat or boiled chicken. She is walking away from things we know she likes lots. The past few days, she has had a bit of diarrhea and vomiting, sleeping a lot, but still occasional playful moments. Right or wrong, I took her off the Trilostane two days ago (Oct. 11) with the intent to keep her off of it for one week then put her on a daily 15 mg dose for two weeks before repeating the ACHT SSTIM test.

You did the right thing and I personally would not restart her on the same dose. Knowing what I know now, I personally would feel more comfortable with 10mg am and pm.

Has it been your experience that they do better dosing twice daily. Didn’t I read that the Trilo only really stays in their system about 8 hours?

We would be so very grateful for any insight from those who have walked this path.

I had two cushdogs until June when one of my babies passed. Both of them treated with Lysodren, then switched to Trilostane for two years and back to Lysodren. The reasons for the switches is a long story but I am quite familiar with both drugs. I'm a seven year canine cushing's veteran so I have walked down this path in your shoes. The only difference between us is that I've had seven years to educate myself....actually it's more like obsessive compulsive research.

I am so sorry others have experienced all that we are going through right now, but also comforted to know that we have someone to lead us through it all. Thank you so much. Everyone has been wonderful!

[Anniston's Mom]

Thanks for the information about IMS Vets. We will definitely follow up. In fact, we saw our vet today because Anni vomited off and on for several hours during the night. She did not get dehydrated, but I wanted to talk with him anyway and also have her skin issued checked. During the conversation, I asked him about adding an IMS to our team to oversee the Cushings treatment. He is very open to that and we plan to discuss it further when we (hopefully) do her ACTH Stim on Thursday. Those results will then be the guide as to whether or not to restart the Trilo at a lower dosage right away or wait.

Again, I cannot tell you how happy we are to be adopted into this family of concerned furbaby parents.

Glenda & Anni

[Harley PoMMom]

If the vomiting continues, an ACTH stim is needed ASAP. Vomiting can be a symptom of too low cortisol and prednisone is given when this happens. Has Anni's electrolytes been checked recently?

Hoping Anni is feeling much better soon.

Love and hugs,
Lori

[Anniston's Mom]

She did vomit 2-3 times a few days ago when she also had the diarrhea and we decided to take her off the Trilo. Other than a reluctance to eat, water intake and all output was fairly normal for the next couple of days. She was very playful last night. Normal bedtime. Woke up at 2:30 vomiting. Continued off and on ‘til close to 6:00am. No more vomiting today. Ate a tiny bit of baby food (recommended by vet) and one small poop. hopefully we are making progress. She is lovey and clingy tonight. Right now with her Dad.

Thanks everyone. I feel I am learning something new everyday!

Glenda & Anni

[Anniston's Mom]

I just realized that I haven't mentioned that I am a number cruncher by career, but by education a near major in biology and, years ago, liscensed as an intermediate EMT with the state of AL (licensed, but never practiced).

[frijole]

Hello from me as well! Not sure if your vet told you so wanted to make sure you know that vomit and diarrhea are signs of too much trilostane. It means the cortisol has gone too low. I would have an acth test done asap. I think you said you had ceased giving trilostane. Please no more until after you have had an acth test. Keep us posted! Kim

[Squirt's Mom]

Hi,

I edited your post to add color to yours and to Glynda's words within that post. If you'd like help learning how to quote and format posts, just holler! :) It's real easy - if I can do it, anyone can! :D

Do you notice Anni walking hunched over or does she seem tender in the belly area? You might want to talk to her vet about pancreatitis today. Also, I wouldn't wait until Thurs for the ACTH - I would get that done today if at all possible.

Keep in touch and let us know how she is doing.
Hugs,
Leslie and the gang

[Anniston's Mom]

Yes, I would love to know how to format. I actually pasted it over from Word, but it did not carry over the formatting.

Anni does not seem at all tender in the belly and has not. In fact, she rolled over this morning to get her usual morning belly rub. She did not throw up any yesterday and had a small more normal stool last night and another this morning. She actually ate a bit both last night and this morning and has not vomited since 5:30 yesterday morning. No temp either.

[Anniston's Mom]

For all who asked, here is the bio for Dr. Wood, the vet who performed Anni's ultrasound. He is at Riverview Animal Hospital in Birmingham.

Dr. Wood is one of the owners of Riverview Animal Clinic and has been practicing Veterinary Medicine since 1981. His talent in ultrasound diagnostics and oncology is sought after by many of his peers in Alabama. He sees a wide variety of patients and has many cases to manage, all the while keeping pace with the constant challenge of staying current with Veterinary medical practices due to the rapid pace of medical and surgical advancements.
Dr. Wood attended both UAB and Auburn University for his undergraduate work, and graduated with a DVM from Auburn. He is affiliated with The Veterinary Cancer Society, the AVMA, and the Alabama VMA.
When he is not at the clinic, Dr. Wood and his wife, Janet, are very active outdoors — either puttering with the landscaping in their yard, keeping up with their young son, Morgan or taking part in his son Jordan’s scout troop. On fall weekends, you can probably find them at the Auburn Tiger’s home games. He also loves water and snow skiing, personal fitness, and hiking and camping outdoors. 
Dr. Wood and Janet have a Labrador Retriever named Dakota, and a German Shepherd named Kenyan.

[Squirt's Mom]

Ok...if you will look in the lower RH corner of the post you are replying to, you will see a "quote" button. Click that button and the reply box will pop up with the post you quoted already showing.

To enter replies to specific comments throughout the post the way Glynda (lulusmom) did, you will move the cursor to the end of the sentence / paragraph you are responding to and hit "enter" twice. This will move the cursor to an open area where you can start typing. BUT before you start typing, look up at the top of the blue reply box and you will see a formating bar very similar to the one on MS Word - B, I, U, etc. Just above that bar you will see the double AAs, a box to change fonts (click the down arrow), a box for sizing the type (down arrow), then a capital A underlined with a down arrow beside it. Click the down arrow and a box of colors will pop up. Choose the color you want to use in your reply and click on it. Where your cursor is in the open area of the reply box, you will see [ followed by the word color in capital letters, followed by = and the chosen color in " ", then ] followed by [/ and the word color in caps again followed by ]. That is the syntax for the color you chose. The cursor will be flashing between the ][ and that is where you have to type to get the color. It will look something like this - * but "word" will be COLOR and the * is where your cursor will be flashing and where you have to type.

Repeat this process for each statement / paragraph you wish to respond to.

Once you are finished responding to specific points within the post, move your cursor to the final ] at the end of the quoted post. From that point on, your type will be black as normal. If it is easier, you can continue within the quote using your chosen color.

It is best NOT to use the "quote" feature for every reply, tho. ;) We keep all the history about each pup in their own thread so it isn't that difficult for readers to look back if needed.

If there is some small part of a post that you wish to reply to, you will use your cursor to highlight and copy that section from the post, then hit the "reply" button as usual. When the reply box opens up, left click in the box and choose "paste". Your chosen section will copy.

Now, this is going to get confusing because I can't show you the correct order to type the next part or it will perform the action, not show you what to type. So, you are going enclose your chosen section in this arrangement - this part last, at the end of the selected portion [/QUOTE] and this part first at the beginning of the selected portion [QUOTE] - with the portion you wish to reply to between the ][ . The only difference is that at the end of the quoted part you add the / in front of the word QUOTE.

That will enclose that chosen section in blue once your post is submitted. After typing the final ] hit enter twice and start typing as usual - your font will be in black.

You can open this site in two windows to look back and forth if that will help...I do it often myself when there are multiple things I need to see at once. ;)

Hope that helps!

[Anniston's Mom]

Great instructions. Thank you. I,ve actually already opened the site in multiple windows several times.

[lulusmom]

Hi Glenda,

I asked about the ultrasound findings relative to the adrenal glands and the liver so I'm looking forward to your posting that information. It would actually be great if you could round up all of the bloodwork that has been done and post the highs and lows here, and please include the normal reference ranges. With respect to the ultrasound Marianne (Labblab) did have questions about the vet who did the ultrasound. See below:


I do have a question, though. You mention that you were referred to a specialist for Anniston's ultrasound -- where was that specialist located, and was he/she the one who diagnosed the pituitary form of the disease and made the suggestion to switch to trilostane?

Looking forward to more information on your girl.

Glynda

[Anniston's Mom]

Hi Glenda,

I asked about the ultrasound findings relative to the adrenal glands and the liver so I'm looking forward to your posting that information. It would actually be great if you could round up all of the bloodwork that has been done and post the highs and lows here, and please include the normal reference ranges. With respect to the ultrasound Marianne (Labblab) did have questions about the vet who did the ultrasound. See below:



Looking forward to more information on your girl.

Glynda
Post #15 has the bio for the doc who performed the ultrasound. I'll try to post the results soon. Is it possible to scan and attach? JPG file or other? The report is two pages.

Other than the bloodwork to test for diabetes, and the ACTH tests, Anni hasn't had other bloodwork. Are you specifically looking for something other than what is in the first post? Also, do you suggest having electrolytes tested everytime an ACTH is done? Any other suggestions? Still no more vomiting so ACTH planned Thursday morning.. Glenda - Anni's Mom

[Squirt's Mom]

Hi Glena,

The ACTH is used for diagnosis but cannot be used as the only test to base the diagnosis on because there are many, many things that can cause this test to show elevation in the cortisol that have absolutely nothing to do with Cushing's. The ACTH is primarily used to monitor treatment, not to diagnose.

The diagnostic tests are the UC:CR, LDDS, HDDS, and ultrasound. If Anni has only had the ACTH, I would not be at all comfortable starting treatment with either drug...and if your vet who didn't know how to use Lysodren is the one who said she has Cushing's based only on this one test, you need a different vet asap because it does not look like they understand Cushing's nor are they trying to learn and keep up. You're vet is making me very nervous. :o

In the lab work that looks at diabetes we typically see very high elevations, sometimes too high to register, in the ALKP - Anni's was "slightly high". We typically see elevation in cholesterol, some protein in the urine, and other indicators that are not present in Anni that we have seen so far. That is why we are asking to see the actual results - the diagnosis is in question which puts the use of these drugs she's been given in the no-no category.

It is sometimes possible to scan reports in, but the are sometimes difficult to read that way. On the blood work, all we need to see are those values that are too high or too low. On the Cushing's tests - UC:CR, LDDS, HDDS - we need to see all the numbers and the interpretation notes following those numbers. On the ultrasound we need to see any comments made that mention the adrenals, liver, kidneys especially and any other comments about any abnormalities found. The U/S will sometimes offer possible causes for the things seen, and we would like to see those comments as well.

Nosy, ain't we? :p Not really - we just want to help you and Anni, and make sure you are actually dealing with Cushing's. And that is a big question in my mind right now. ;) While her signs are seen with Cushing's, they are also seen with a multitude of other conditions.

Hugs,
Leslie and the gang

[Anniston's Mom]

Oh no, I do not think nosy, I think interested. I hope one day to know enough about this crazy disease to ask questions too. At first, we were overwhelmed with the symptoms and the diagnosis of a disease we had never heard of. As time goes by though, we feel like we are learning something every day.

On May 31, 2012:
ALT was 287 U/L with Reference Interval of 10-100
ALKP was 650 U/L with Reference Interval of 23-212

Ultrasound performed August 24, 2012:
Liver: Mild hepatomegaly. Lobar margins are slightly rounded. Parenchymal echogenicity is somewhat variable. No focal lesions observed.

Kidneys: Both right and left normal

Adrenals: Right – Adrenomegaly. Nodule on caudal pole >8mm. Left – Also has a nodule on the caudal pole. Not quite as large as the right.

Additonal Comments: although bilateral tumors are possible the findings are most consistent with PDH. Since she has not been responsive to Lysodren I would try switching her to trilostane. Our normal starting dose is 5-10mg/kg, but we elected to start her at 15mg since she has been on an extended round of lysodren. I advised the owners to increase her dose to 30mg if her water consumption has not decreased after 5-7 days of therapy. I would repeat her ACTH stim after 2 weeks if she is responding to the 15mg dose or 2 weeks after increasing her to 30mg regardless of her clinical signs.

Symptoms Anni was displaying when all of this started back in April:

• increased/excessive water consumption
• increased/excessive urination
• urinary accidents in previously housetrained dogs
• increased/excessive appetite
• begging for food when she had never done so before
• sagging, bloated, pot-bellied appearance
• loss of muscle mass, giving the appearance of weight loss
• exercise intolerance, lethargy, slight hind-leg weakness
• new reluctance to jump up in “her” chair
• a distinct panting
• symmetrically thinning hair or baldness (alopecia) on torso
• other coat changes like dullness, dryness
• thin, wrinkled, fragile skin

[lulusmom]

Hi Glenda,

Thank you so much for posting more information on Anni. With the symptoms you posted, your girl is a walking poster dog for canine cushing's. Like my own cushdog before diagnosis, Anni seems to have almost every symptom in the book. Symptoms are a everything in making a confirmed diagnosis so that's not an issue here. Dr. Woods' experience with the disease and it's treatments is an issue based on his comments in the ultrasound findings. Can I assume that Dr. Wood is your gp vet as well as the technician who did the ultrasound? I say this because some of Dr. Wood's comments are reflective of a vet with little cushing's experience. I would like to respond to some of his comments in the event new members may read them and believe they are appropriate based on Anni's treatment history, proper treatment dosing recommendations and treatment monitoring protocol.


Additonal Comments:

1. Since she has not been responsive to Lysodren I would try switching her to trilostane.

Anni's lack of response to lysodren was not because she was resistant to lysodren, thereby needing to throw in the towel and try another drug. She didn't respond because her vet didn't follow proper treatment protocol. As I mentioned in a prior post, Anni's response to the miniscule dose of Lysodren should have been expected. An experienced vet never would have prescribed an ineffective dose of less than 15mg/kg per day, much less that tiny dose every other day and expect to see any change whatsoever.

Our first gp vet was totally ignorant and thanks to him and my placing blind faith in him, my dog went undiagnosed for almost two years. Thank heavens cushing's is a slowly progressing disease and no lasting damage was done. She was eventually diagnosed by an internal medicine specialist and it took me a long time to find a cushing's savvy gp vet. With the exception of her position on annual vaccines, she was perfect. If she didn't have an answer, she called an internal medicine specialist for guidance. Had your vet consulted with an IMS at the outset, I'm pretty sure, Anni would be on Lysodren at an effective dose.

2. Our normal starting dose is 5-10mg/kg, but we elected to start her at 15mg since she has been on an extended round of lysodren.

Yikes, that starting dose is dangerously high and I'd like to know where he came up with this range? Thank goodness you started Anni at 15mg and thank goodness you stopped the dosing. Please refer to manufacturer's dosing recommendations (url below) and please, please share them with Dr. Wood so that he can educate himself and not put dogs at risk.

http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf

3. I advised the owners to increase her dose to 30mg if her water consumption has not decreased after 5-7 days of therapy. I would repeat her ACTH stim after 2 weeks if she is responding to the 15mg dose or 2 weeks after increasing her to 30mg regardless of her clinical signs.


It is so odd that the Lysodren dosing was ridiculously low and Dr. Wood's recommended starting dose to Trilostane is riduculously and dangerously high. Not all dogs on Trilostane will see resolution of excessive drinking and peeing. It may take two weeks or longer to see a change and if Dr. Wood is familiar with the drug, he would know that studies show that some dogs on Trilostane never have resolution of this symptom. Because all dogs respond differently, you cannot base efficacy on resolution of symptoms alone. You must follow treatment monitoring protocol and perform acth stimulation tests as recommended. Anni is very lucky that your vet's egregious ignorance hasn't landed her in the er on IV fluids. Anni is so very lucky to have you as her mom and advocate. Good for you.

To answer one of your questions about checking electrolytes, yes, your vet should check electrolytes every time a stim test is done. This is something your vet would have known had he educated himself on the drug he prescribed. It is well known that trilostane can not only reduce cortisol but it can reduce aldosterone, a mineralcorticoid which regulates water and electrolytes. If aldosterone is too low, it can be even more life threatening than low cortisol.


Glenda, I have mixed emotions here because I want to tell you to run, not walk away from your vet and get Anni to an IMS but I also have grave concerns for any cushdog who walks through his door. General practioner vets can be the best vets in the world with day to day canine conditions but a lot of them are woefully lacking the experience and education needed to safely and effectively diagnose and treat a cushdog. I think that may be an accurate assessment of your vet so working with you and an IMS could greatly benefit him and his patients. A good number of us have educated our gp vets and there is no reason why you can't have a gp vet and an IMS that work together.

Sorry for the novel but I've always had a problem with brevity. :D

Glynda

[Anniston's Mom]

Dr. Wood is not Anni's GP vet. He is the one who did the ultrasound and is affiliated with a fairly large animal hopsital in Birmingham. See post #15?

At this moment, my immediate plan is to get the ACTH and electrolyte tomorrow. I really do not want to leave our GP because Anni is a very anxious girl and both he and his tech are really patient and compassionate with her. I did tell him on Tuesday that I think we need to add an IMS to our team. He has never professed to be a Cushings expert though he currently has some patients doing well on Lysodren. He is quite open to bringing in an IMS and I think would be relieved to turn over the Cushings treatments. I'll know more tomorrow.

Thank you so much for your continuing concern and advice. Because of Anni's personality, I want to be sure that the vet we either add, or move to, will accept her as her current doc does. Otherwise, I think the additional stress could make matters even worse.

[Anniston's Mom]

To Lulu's Mom:

. Our normal starting dose is 5-10mg/kg, but we elected to start her at 15mg since she has been on an extended round of lysodren.

Yikes, that starting dose is dangerously high and I'd like to know where he came up with this range? Thank goodness you started Anni at 15mg and thank goodness you stopped the dosing. Please refer to manufacturer's dosing recommendations (url below) and please, please share them with Dr. Wood so that he can educate himself and not put dogs at risk.

Though the statement above is what is typed on Dr. Wood's written report, verbally, he told us that the normal starting dose for a dog Anni's size (at that time about 10 pounds) would be 5-10mg.

[Squirt's Mom]

That is still wrong. The manufacturer of Trilostane (Vetoryl) says to start at 1-3 mg/lb. The dose given to Anni was way too high for Trilo and way too low for Lyso.

I'm afraid you are dealing with two vets who are dangerously ignorant about Cushing's and the treatments for it. :(

[lulusmom]

Hi again and thanks for the additional information.

I agree with Leslie that your vet and Dr. Wood's knowledge of cushing's appears to be scant. The reason I assumed that Dr. Wood was your vet is because his ultrasound comments make it sound like he is directing Anni's treatment. Was your vet using Dr. Wood as an expert and following his recommendations?

If Dr. Wood's bio is accurate, he is highly sought after by his peers for his expertise in ultrasounds and based on the findings you shared with us, that concerns me a great deal. If Dr. Wood inserts his own risky dosing recommendations and questionable assumptions in writing on the ultrasoud interpretation, I would be very concerned that a vet would blindly follow those recommendations, thereby putting dogs at great risk.

I'm just saying......

Glynda

PS: I totally understand your concern about Anni's stress levels at the vet's office. Her well being is paramount so I agree 100% with your plan of action.

[Anniston's Mom]

Hi again and thanks for the additional information.

I agree with Leslie that your vet and Dr. Wood's knowledge of cushing's appears to be scant. The reason I assumed that Dr. Wood was your vet is because his ultrasound comments make it sound like he is directing Anni's treatment. Was your vet using Dr. Wood as an expert and following his recommendations?

Yes, our vet was following Dr. Wood's direction.

If Dr. Wood's bio is accurate, he is highly sought after by his peers for his expertise in ultrasounds and based on the findings you shared with us, that concerns me a great deal. If Dr. Wood inserts his own risky dosing recommendations and questionable assumptions in writing on the ultrasoud interpretation, I would be very concerned that a vet would blindly follow those recommendations, thereby putting dogs at great risk.

I'm just saying......

Glynda

PS: I totally understand your concern about Anni's stress levels at the vet's office. Her well being is paramount so I agree 100% with your plan of action.

I printed Dr. Ellen Behrend's info from the AU website to take with me tomorrow to my vet. I so look forward to getting the test results back!

[lulusmom]

I printed Dr. Ellen Behrend's info from the AU website to take with me tomorrow to my vet. I so look forward to getting the test results back!

Atta girl! This is the way to do it. FYI, Ellen Behrend is one of our country's leading expert on cushing's and most certainly, Vetoryl. I believe she is actually a marketing rep for Dechra as well as a frequent contributor to their veterinarians continuing education program. I'm not sure which paper you printed but here is one that you can find on Dechra's website:

http://www.dechra-us.com/Files/dechraUSA/downloads/Case%20Studies/Clinicians%20Brief-trilostane.pdf

[Anniston's Mom]

Thank you for the article. It is now printed and will go to our vet along with the bio I printed from the University website.

[labblab]

And do be sure to note that Dr. Behrend's dosing recommendations in that article appear as "mg. per kg." rather than "mg. per lb." ;)

Marianne

[Squirt's Mom]

:o I have trouble with foreign languages, ya know! :p

[molly muffin]

I sympathize with the vet issues and stress. I've had my vet for molly since she was 11 months old (when I got her) and she is now going to be 10. Molly thankfully is now comfortable enough that she doesn't try to nip at anyone and actually likes the people who work there. It took her about 5 years to really get to that point. I am loath to leave for that reason, but it's been a battle with this cushings stuff. 2 years ago, they tested her for cushings due to high ALP. LDDS, negative. Again this year, they tested her because of high ALP and ALT, they did an ACTH, result High positive cushings. And then came the forum here and me trying to learn everything possible about this disease. My vet is not as accommodating as yours and I was told not to read the internet, that she makes the calls on tests, etc, on and on, with us doing battle at every visit where I wouldn't start my 18.4 lb dog on 30mg of vetroyl. I demanded an IMS consult and ultrasound (you'd thought I'd personally betrayed the vet) and thankfully the IMS recommended an LDDS test, which showed, once again, negative for cushings. I could have harmed my precious molly if I'd gone the route my vet recommended. *sigh*

So, here we are. She still sees her vet, who has calmed down some, but never apologized for the misdiagnosis issue, and I will take her to the IMS if there is a cushings issue. I think as long as I am vigilant, I can get most all her regular stuff from this vet, whom she is comfortable with, but for something serious, we'll be seeing the IMS. Whom I am more in tune with. For instance my IMS said, she's start molly at 5 or even 8 mgs of trilostane rather than 30. Electing to be able to increase and not hurt her, rather than start too high. We haven't gotten there yet, but you see what I mean.

So I know this is a tough road to go down. The more you know though, the better for Anni and for you. I seriously do not know what I'd have done without this forum and the helpful people here who have already walked this path and know the pitfalls along the way. That's the best way to describe it.

You'll be fine. :)

hugs, to you and Anni

[Anniston's Mom]

Anni’s water consumption has remained steady since my last post and though she is resting a bit more than normal she remains bossy and can quickly spring to attention if someone comes to the door. Our issues this week have been trying to get her to eat. She has lost a couple of pounds over the past 3-4 months. Recently, she has refused kibble completely and over the past week or two has eaten mostly small amounts of cooked chicken. What little stool she has is very runny. She also does not want her pill pockets (with or without pills) so it has become more difficult to get her daily Levothyroxine down. She has only vomited once in the past week, but last night, she was very extremely restless. Any thoughts would be most appreciated?

Test Results on 10/19/2012 after being off Trilostane for one week were:
Pre-ACTH 1.2 ug/dl Post-ACTH 1.6 ug/dl

Sodium/ Potassium/ Liver and other enzymes normal with the exception of the following which were low:
TP (4.4 g/dl) Ref. 5.2 – 8.2
ALB (2.0 g/dl) Ref. 2.2 – 3.9
GLOB (2.4 g/dl) Ref. 2.5 – 4.5
AMYL (497 U/L) Ref. 500 – 1500

[lulusmom]

Hi Glenda,

I thought the 9/12 stim results of Pre-ACTH 2.2 ug/dl and Post-ACTH 1.8 ug/dl were scarey low for only two days on the increased dose but the latest results are definitely too low for my comfort. Does your vet know that Anni is still showing signs of low cortisol? If not, I would suggest you call him and discuss the possibility of giving her a rescue dose of prednisone to see if she perks up. If it's low cortisol that is causing the inappetence, extreme lethargy and continued diarrhea, you'll see an improvement rather quickly after dosing with prednisone.

Glynda

[Anniston's Mom]

Glynda, This morning when I talked with our vet, he immediately suggested the same and told me to touch base tomorrow. One dose in and a little food down the girl tonight. Praying tomorrow is better. This is a crazy week for us as we are involved in a major fundraiser scheduled for Saturday. Thank you and all on this site for your continued concern and support.
Glenda

[apollo6]

Dear Glenda

Welcome, your Anniston is a sweet heart.
My AngelApollo was on Trilostane. I am some what alarmed that Anniston was put on such a high dose to begin with. Apollo weighed 10 lbs and was on 10mg. I could Not go higher because his cortisol would drop to much. I am still grieving his loss. He would have been 14 Oct 12th. If you have any questions you can always ask me.
You could try an internal medicine speaking-IMS. There is a website you can find a specialist in your area, I would have to look up.
Hug Sonja and Angel Apollo. You can see my video tribute to Apollo on the last few postings of my thread if you like.
I am not sure if you did an ultrasound? Anniston may have stomach/intestional issues, also I think, but not sure if Trilostane can cause weight loss. You can email Dechra-website(the manufacturer) they have an email address to ask about some of the issues Aniston is having. The weight loss worries me. But please know we are not doctors. I can only share my experience. Always check with a vet before you try something new.

[Anniston's Mom]

Sonja, I just watched the beautiful video tribute to your AngelApollo and type this through my tears. What joy Apollo must have been in your life . Your tribute clearly reflects the love between you two and my heart aches for you in your loss. I know your grief surrounds you, but pray that your happy memories will bring you comfort and healing in time.

Thank you for your suggestions. I realize that this road we are on is a long and winding one and it is wonderful to have all of you guys to hold our hand and lead us forward. I am a bit concerned that Anni's cortisol levels are so low, but she ate better yesterday and was quite playful last night. Hoping that is a good sign. She did have an ultrasound. Details are several posts back. I am so glad some of you suggested starting a log. That's the only way to keep up with all that's being thrown at us by this crazy Cushings.

Glenda & Anni

[apollo6]

Dear Glenda
will try to post the sites for you , I mentioned. I took Apollo off Trilostane a few times during the 3 years he was on it. Please keep copies of all tests, and labs. And a chronicle log on any changes Annoston has,eg.weight loss, diarreha,etc. If you have any concerns about your angel, call the vet, ask questions and listen to your gut feeling. You know her better than anyone.
Hugs Sonja and Apollo

[Anniston's Mom]

Things are looking up, at least for the moment. 2.5mg of Prednisone last night and again this morning and Anni(ston) actually stuck her nose in her kibble tonight and ate about 1/4 cup. First time in almost three weeks she has volunteered to eat anything other than cooked chicken or toddler meat sticks. ...and believe me when I say we have offered her not only several types of soft dog food, but several people foods too! Our vet wanted calories in her in any form! Are we now in Addisons?

Another thing I wonder about is that Anni has never had a great coat. Her tummy has been bare her whole life. In the last 30 days she is so furry. Bare spot on tail filled in. Heavy peach fuzz on tummy. So much hair on her neck area the vet almost clipped it fot the ACTH last week. Any thoughts? Our girl will be 11 on Saturday.

[molly muffin]

The quick response to the pred is a good sign. It does mean that the cortisol was too low and she had to be helped though.

Yes, when cortisol is controlled, hair can start growing back into the areas that it has gone thin in. That is good. :)

Glad the pred is working so well.

hugs,
Sharlene

[apollo6]

Dear Glenda

Apollo never had hair on his bellow or neck his whole life either , than after taking Trilostane he grow hair on his neck and a little on his bellow. If the medication is working Anni should be drinking less and hair should be growing back.
site to chose an internal specialist, scroll down fill in the state, etc.
http://www.acvim.org/websites/acvim/index.php?p=3
information about the types of cushing
http://www.dechra-us.com/Cushings-Syndrome/Veterinarians/What-is-Cushings-Syndrome-1.aspx

scroll down page and click on pdf of vetoryl/trilostane to read info and at bottom says contact us , can email questions have. If you are still on the TRilostane.

Cushings is a roller coaster.
Hugs Sonja and Angel Apollo

http://www.dechra-us.com/US-Products/Products.aspx?pcatid=PROPFIELD465&catid=PROPGRP37&fid=&ProductID=PROD247

[Anniston's Mom]

Sonja, the Trilo worked really fast. Anni(ston) went from 48-55 ounces of water a day to 24 and downward in only 3 days. Within a couple of weeks, she was down to 12 ounces. Today, water is fairly normal. Now we wonder if the Trilo has pushed her into Addisons. Time will tell, I suppose. Meanwhile, we are amazed with her hair growth. She is fluffier/fuzzier at age 11 (Oct. 27) than she has ever been in her entire life.

[Squirt's Mom]

Hi Glenda,

Just because the cortisol got too low and Anni needs the pred right now, that doesn't necessarily mean she is now Addison's. Often we see the pup rebound with pred, the signs come roaring back when the pred is stopped, the ACTH show elevations in the cortisol again, and treatment is restarted at either a lower dose or with the other drug. We also see pups on Trilo go into a sort of remission that can last for months in which they require neither pred nor Trilo, then signs resume at a later date. So for right now, I would just keep up the pred as directed. At some point soon, you will start to wean her off the pred and see what happens.

Keep in touch and let us know how she is doing!
Hugs,
Leslie and the gang

[Anniston's Mom]

Thanks Leslie and the gang,
Great explanation. Seems I learn something new every single day about Cushings.

Anni(ston) started 2.5 mg Pred Momday evening. Tonight was her 5th dose at this level. I talked with the vet last night and he suggsted reducing to 1.25 mg beginning tomorrow morning then touching base again the first of the week as long as the improvement continues and there are no other changes. She isn't 100%, but certainly more playful and much more interested in her food which makes me very happy!

Thanks for being so patient with this newbie!

[apollo6]

Just keep monitoring Annie and if you notice any changes inform the vet. If she starts vomitting or not eating than call the vet. I did not have any symptons with Apollo. But he had to stay on the lowest dosage, 10mg. because when I tried a larger dosage he threw up and his cortisol dropped to low. So be very careful.
Hugs Sonja and Angel Apollo
Also look at the links I gave you in my last post for more info.

[Anniston's Mom]

Sonja, 10mg daily or twice daily?

[apollo6]

Apollo was only on Trilostane 10 mg once a day.
But please know each dog/Patient is different.Addy's Zoe is on 30 mg.
I just Feeling with a dog weighing ließ than 10 LBS, 30mg is a Little High. Please Check Out DEchra 's website on Trilostane/vertroyl . You can also email them with questions. Addy and I have numerous times.
Hugs Sonja and Angel Apollo

[Anniston's Mom]

Any thoughts about incredible hair growth? In about a month's time our girl's coat has undergone a puzzling transformation. Even the texture has changed.

[Harley PoMMom]

Trilostane has been used in non-cush dogs that a skin/hair issue called Alopecia X, it seems to have helped with regrowth.

Link to one article of many: http://www.ncbi.nlm.nih.gov/pubmed/16141187

[Anniston's Mom]

Trilostane has been used in non-cush dogs that a skin/hair issue called Alopecia X, it seems to have helped with regrowth.

Link to one article of many: http://www.ncbi.nlm.nih.gov/pubmed/16141187

Yep, I am familiar with that article, but in our case Anni has more hair than she has ever had. She is almost fluffy. Like most Doxies, she sleeps with us and my husband and I are joking that we no longer recognize her in the dark.

[StarDeb55]

Glenda, a lot of members have reported this "coat blowing". It appears that when the cortisol is brought down to a more healthy level, the pup will blow their coat as the hair follicles appear to be unhealthy due to the high cortisol. Members report that the regrowth is frequently a totally different texture than before, & possibly a difference in color. I don't think it's anything to worry about.

Debbie

[molly muffin]

wow, that is pretty amazing. I haven't a clue, but must assume that in Anni's case her body has reacted like hair growth on steroids to the Trilostane.

Sharlene

[Anniston's Mom]

Glenda, a lot of members have reported this "coat blowing". It appears that when the cortisol is brought down to a more healthy level, the pup will blow their coat as the hair follicles appear to be unhealthy due to the high cortisol. Members report that the regrowth is frequently a totally different texture than before, & possibly a difference in color. I don't think it's anything to worry about.

Debbie

Sounds like what we are experiencing. There is a dark stripe on her tail where a bare spot had been before. I must wonder just how long her cortisol has been high without symptoms other that a sparse coat.

[apollo6]

Glenda & Anni(ston)
You asked about the coat growth andthe bare tail. Apollo had the bare tail also for a long time, thinking it was some kind of skin issue. He had more hair after taking Trilostane- never had hair on his neck or belly, all of a sudden he grow hair there, his coat changed color to a more golden color , his coat became more soft. Cushing causes imbalance with the sex hormones and this can cause some of the skin issues Anni is experiencing, also thyroid issues can cause hair and skin issues. In my case over use of medications on Apollo after an Er emergency caused his skin to turn black(prednisone) and hives all over his body. I feel the shock of the medications to his little body caused the damage. In my opinion over use of vaccines and certain medications with steroids causes this disease. But every one has there own opinion.
HUgs Sonja and Apollo

Dear Genda
I thought you said you are from San Diego? It helps.
If you are let me know and I will give you my phone number. Rene who lost Snoopy is also from San Diego and we have become good friends and talk and support each other.

[Anniston's Mom]

Glenda & Anni(ston)
I thought you said you are from San Diego? It helps.
If you are let me know and I will give you my phone number. Rene who lost Snoopy is also from San Diego and we have become good friends and talk and support each other.

Nope, Central Alabama.

Thanks for the information about the change in coat. I do realize it is from the medications, but wish I could pinpoint which one. I do know she was on the Trilo when we first noticed it.

[apollo6]

boy am I losing it.
Will hi to you. It is amazing how far this forum reaches in the world. We are blessed to have each other to get through this Cushing journey.
Hugs Sonja and Angel Apollo

[molly muffin]

Hi Glenda :)

How is little Anni doing? Is she a full blown fluff muffin now?

Hope all is well.

Hugs,
Sharlene and Molly Muffin

[Anniston's Mom]

Thought I would give a brief update on Anniston. It would seem that she was overmedicated and had a near Addison's crisis. She is now taking twice daily prednisone 1.25 mg doses each and surprisingly stable for the past several months. Her eating, water intake, bathroom habits, and sleeping habits are near normal. The only real change we continue to notice is the excessive hair growth. I gave her a New Year's bath and am using about three times the shampoo I would normally use. Also, for years and years she would dry in about an hour and yesterday it took her neck over 4 hours to dry even with about 10 minutes of using the hairdryer.

Mostly, I want to thank everyone on the forum who was there for us during the really scary days. I know that things could change and we continue to measure water daily and keep a close eye on our girl. It is comforting to know that I have you guys to turn to when/if that happens. Meanwhile, we are enjoying every single day of near normal that we are granted.

[molly muffin]

Oh my gosh Glenda that is so scary. I'm glad that Anniston is doing okay now.

Happy New Year
hugs,
Sharlene and Molly Muffin

[Squirt's Mom]

Hi Glenda,

SO glad to hear that the crisis was caught and Anniston is doing better. You must have been on the ball, huh? ;) Way to go, Mom! :cool::cool:

Let us know how he is doing on the new dose.
Hugs,
Leslie and the gang